Abstract

INTRODUCTION
Lymphedema is a condition occurring when the lymphatic system fails to efficiently transport the lymph, thus creating a fluid accumulation in the interstitial space [1].
If not treated properly, this disease can worsen over time, reaching a serious and debilitating condition [2].
As of today, the rehabilitation treatment for lymphedema relies on the principles of Complete Decongestive Therapy, a series of manoeuvres designed to favour the reabsorption of the lymph by the lymphatic system and to restore the functionality of the affected limb.
From an osteopathic point of view, interesting results have been obtained through Lymphatic Pump Treatment (LPT), a series of oscillatory techniques applied to different areas of body such as chest, abdomen and feet [3].
A few LPT studies on animals have shown a significant improvement not only in the lymphatic system efficiency (an increase of 271% in lymph flow) but also in the immune system [4,5]. From the scientific evidence derived from such studies, in this paper we propose a clinical trial that aims to demonstrate the benefits that this technique can bring to human beings in a specific rehabilitation process following a lower limb lymphoedema.

MATERIALS AND METHODS
In this work, the following topic are discussed:
− Inclusion and exclusion criteria for the project.
− Examined outcomes (primary and secondary).
− Number and randomization of the sample.
− Clinical case study.
Subsequently the working procedures will be described, for the control group only the 10 sessions of CDT will be administered. While the study group is scheduled for the administration of LPT in 8 sessions in association with the CDT treatment, which will be administered every day. Pre and post treatment tests will also be performed. Both groups are formed by the same patients who initially formed part of the first group and subsequently, after a certain period of time, entered the study group. A volumetric measurement of the lower limbs will be performed according to the segmental technique developed and validated in 2003 by Dr. Giovanni Farina. The measurement will be performed initially for patients before and after physiotherapy only and, in a different period of time, for the same patients before and after the physiotherapy treatment associated with osteopathic manipulative treatment. In addition to the results of this measurement we will consider the results of the Six Minutes Walking Test and the Borg Scale score, compiled by patients belonging only to the study group, then those treated with physiotherapy treatment in association with osteopathic treatment, respectively T0 and T1.

RESULTS
The average of the circumference before the standard physiotherapeutic treatment was 347.4 cm while the one after treatment above mentioned was 326, 2 cm. The average circumference before the standard physiotherapeutic treatment associated with osteopathic treatment was 348.2 cm, whereas after the treatment the average circumference was 329 cm. The average volume before standard physiotherapy treatment was 9470.6 cm3 while after treatment the average is 8429 cm3. . The mean volume before the standard physiotherapeutic treatment associated with osteopathic manipulative treatment was 9608.5 cm3, whereas after treatment the mean was 8267 cm3. Differently from what was shown in the data relative to the volumetric measurements, there was no statistical significance in the data concerning the Six Minute Walking Test and the Borg Scale due to the reduced number of samples to which they were administered

CONCLUSIONS
Despite the small number of cases examined, the treatment described in this project has led to positive and statistically significant results, in terms of absorption of lymphedema, especially reducing the volume of the limb. It was also demonstrated a statistical non- significance relative to the secondary outcome (Six Minutes Walking Test and Borg Scaa) because due to the reduced sample size the T-test gave a P-Value result greater than 0.05 thus demonstrating its not significance.